Contraceptives Flashcards
Mirena Coil
Definition:
Flexible plastic device that contains slow-release progesterone (levonorgestel) (intrauterine system)
Benefits:
Periods are lighter/less painful
Limited side effects due to low dosage
Works for 3-5 years
Instantly reversible
If placed with first seven days of cycle instantly effective (if not wait 1 week)
Contraindications:
Untreated infections
Breast cancer (past five years)
Endometrial cancer
Cervical cancer
Very large fibroids
Unexplained bleeding
Liver disease
Arterial disease
Disadvantages:
Irregular bleeding
Does not protect against STIs
Risk of pelvic infection
Complications:
Expulsion
Ovarian cysts
Damage to womb
Displaced - transvaginal USS to ascertain location, abdominal XR next line
IUD
Definition:
A plastic device which releases copper to prevent pregnancy.
Benefits:
Emergency contraceptive
More than 99% effective
Lasts for 5-10 years
Instantly effective/reversible
Safe for breastfeeding
Does not interact with other medications
Disadvantages:
Heavier, longer periods
No protection against STIs
Risk of pelvic infection
Risk of recurrent thrush
Confirmation of no pregnancy 3-4 weeks later
Complications:
Expulsion
Damage to womb
Rejection
Pelvic inflammatory disease
Ectopic pregnancy
COCP
Definitions:
Pill containing both oestrogen and progesterone
Contraindications:
UKMEC 4: Pregnancy, smoker >35 years who smokes>15 daily, obesity, breastfeeding<6 weeks post partum, thrombosis before 45 years, breast cancer or recent cancer, BRCA genes
UKMEC 3: Breastfeeding > 6 weeks post partum, previous arterial or venous clots, continued use (not initiation) after heart disease or stroke, migraines with aura, active disease of liver/gallbladder
Drug interactions:
Rifampicin and some anti-convulsants decrease efficacy
Oestrogens antagonise warfarin
Oestrogens increase plasma corticosteroid levels
HRT
Definition:
Small doses of oestrogen and progesterone (if uterus present).
Indications:
Symptomatic relief
Decreased risk of osteoporosis and colorectal cancer
Premature ovarain insufficiency
Contraindications:
Undiagnosed vaginal bleeding
Pregnancy
Breastfeeding
Oestrogen receptor-positive breast cancer
Acute liver disease
Uncontrolled hypertension
History of breast cancer/VTE (transdermal preferred if risk of VTE)
Recent stroke, MI or angina
Side effects:
Breast tenderness, leg cramps, bloating, nausea, headaches (due to oestrogen)
PMS like symptoms, mood swings, breast tenderness, backache, depression, pelvic pain, fluid retention, weight gain (due to progesterone)
Cholestatic jaundice
Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease
